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Alcohol Use Disorder is Not a Choice: Understanding and Supporting with Mental Health First Aid

Anthony Campbell

Many of us may be familiar with the phrase, “Hindsight is 20/20.” I know I am. I routinely wish I had known many of the things I know now when I was younger, especially regarding my mother’s life-long challenge with alcohol use.

My experience with my mom is not the first of its kind. After years of watching her drinking get progressively worse, eventually to the point that she could not work or maintain strong relationships with my dad or I, I began to … well, almost hate her. At about 16, I packed up my clothes in large garbage bags and moved out. 

After that, there were many years of minimal contact, although we did remain in touch. Ultimately, through her recovery, we were able to find ways to have a wonderful relationship. My mom had many periods (at one point about seven years) where she found relief from her challenges with alcohol and was able to live a happy, quality life. I love and miss her dearly, and today I share what I’ve learned from Mental Health First Aid (MHFA) about supporting those living with alcohol use disorders and caring for ourselves as supporters. 

I’ve found MHFA’s 5-Step Action Plan (ALGEE) to be a helpful roadmap: 

First, approach the person. When we recognize concerning behavior changes in a loved one, co-worker or friend, determining when to say something is a critical — and difficult step — in supporting them. Often, we are afraid we will anger them when we tell them we have noticed they are drinking more often, consuming more drinks, and/or consuming harder alcohol – and that these changes are negatively impacting them at home, work and in their community. 

As you approach the person, it’s important to remember that you genuinely care for them and to understand that substance use challenges are not a choice. Often substances such as alcohol are used to overcome or reduce pain stemming from traumatic experiences. For example, my mom lived with trauma throughout her childhood, and each of her three siblings responded differently: through alcohol use, illicit drug use (which led to incarceration) and workaholism. That my mom outlived each of them, is almost certainly because my dad never abandoned her or me.

When things are calm, spend time planning for this important discussion. Consider your observations, and how to discuss your perception of the impact the drinking is having on their quality of life and the people around them. Have this discussion in a comfortable and neutral location, when all parties involved have adequate time, and do not involve alcohol. 

The second step, listening nonjudgmentally, allows the person to share their perception of the impact their behavior is having on themselves and those around them. As Mental Health First Aiders, we should meet the person where they’re at and listen as they share about events or experiences that influence their drinking habits and behaviors, such as trauma or unmanageable stress. 

Be prepared for the person to not want or believe they need support. This is a common response to our voiced perceptions of someone’s drinking habits and their impacts. The person may get angry, shut down or even leave.

If the conversation does not go as planned, all is not lost. Even if they don’t immediately acknowledge a problem exists, when we treat people with respect and dignity and show genuine empathy, they will know we care and are there for them. It is not unusual for a person to initially discount these concerns, only to later realize they may need support after all and take the first step towards recovery. 

Give reassurance and information. Ensure the person knows you care, you are there for them and recovery is possible. Throughout the discussion, you may empathize with them, though you do not have to agree with the reasons for their drinking habits and/or their negative impacts. Be careful to avoid saying things like, “I’m always here for you,” unless you mean it and can always be available. 

A highly successful way to be there for someone is to create a support team of family, friends, co-workers, etc. Most of us are not available 24/7 — we have full lives with jobs, families and other responsibilities. Recovery from substance use challenges will often be a life-long journey, and as supporters, it’s a good idea to ensure the person has a network of resources. That way, you can give yourself grace knowing that sometimes, you may need to step away from actively participating in another’s recovery journey to care for yourself. 

Encourage professional help. There are many resources available to aid a person in their recovery from alcohol use disorder. Alcoholics Anonymous (AA) is among the most well-known and effective programs. For many years, my mom attended AA meetings and volunteered for her local group. These were among her best years of recovery because she allowed herself to feel valued and cared for by others experiencing similar life events. She was even able to positively impact group members just starting their paths to recovery. 

Lastly, encourage self-help and other strategies. No one impacted by a mental health or substance use challenge exists in a vacuum. I encourage supporters of someone living with alcohol use challenges to consider Al-Anon. Al-Anon groups support those worried about someone – from family members to romantic partners — living with a drinking challenge. Their website emphasizes that those who are closest to a person with an alcohol use challenge often “try to control their drinking for them. We take on the blame, guilt and shame that really belong to the drinker;” in turn, supporters can become unwell themselves. Taking care of ourselves is vital and will allow us to be our best self for the person we are supporting.

If, over time we become estranged from the person we care about, they may become isolated and struggle to stay on their recovery journey. I did not support my mom by attending AA or Al-Anon events, and there were times when her one and only support was my dad, who never gave up on her. He was fortunate enough to enjoy many years of her sobriety before he passed away. 

When I became involved with MHFA in 2016, I began to understand that substance use challenges are truly not a choice. There are many factors that impact our behaviors, including drinking alcohol. After my dad passed away, my mom and I became closer than ever before. She remained sober for most of her remaining years and I gained a better understanding of how not to take her negative behaviors personally and still be there for her. I learned how to truly support and love her for all she sacrificed for me throughout my life. 

I’m fortunate to know what I know now. I hope that by sharing a little piece of my story, I’ve helped you better understand the experience of someone living with an alcohol use disorder and given you some tools to support them. 

To learn more about the MHFA 5-Step Action Plan (ALGEE), get trained as a First Aider. Find a class at MHFA.org. 

References:

Al-Anon Family Groups. (n.d.). Frequently Asked Questions. Al-Anon Family Groups. https://al-anon.org/newcomers/faq/

Brookdale Premier Addiction Recovery (n.d.). Is Addiction a Disease or Choice? Brookdale Premier Addiction Recovery. https://brookdalerecovery.com/is-addiction-disease-or-choice/

Hill, T. (2019, March 25). Is addiction a choice? Mental Health First Aid. https://www.mentalhealthfirstaid.org/external/2019/03/is-addiction-a-choice/

Mental Health First Aid USA. 2020. Mental Health First Aid USA for adults assisting adults. National Council for Mental Wellbeing.